Palliative Care (PC) consultation intervention services are increasing dramatically in the acute care hospital setting with minimal knowledge of all that this intervention entails. The overall purpose of this 4- year ethnographic study is to develop a thick description of the multiple facets that a palliative care consultation service entails, how they work, their barriers and facilitators, and their specific outcomes in the context of the acute care hospital culture. There is strong evidence that care providers inadequately manage pain and other symptoms such as dyspnea and fatigue in the acute care setting, especially for patients near the end of life. There are difficulties in communication, treatment decision-making, and, when necessary, end of life planning with hospitalized persons with serious and/or life threatening illness. The number of adults living longer and living with serious chronic illness requiring periodic hospitalization is growing rapidly. In recognition of these and other concerns, hospitals are developing multidisciplinary palliative care programs. However, the integration of PC into acute care settings is challenging because palliative and acute care specialties arise from two separate cultures, the former from a hospice culture and the latter from a curative culture. The specific aims include: 1) To describe and analyze the intersection of palliative care and hospital cultures as well as the facilitators and barriers associated with PC consultation in the hospital setting; 2) To describe the patterns of aggressive and palliative care treatment goals and how they change over time in both sequential and concurrent PC consultation; 3) To examine the experiences and culture of PC consultation from the perspectives of patients, families, the referring and PC consultation providers; and 4) To describe the outcomes of PC consultation from the perspectives of patients, families, and the referring and PC consultation care providers. This timely study will help fill a critical gap in the scientific knowledge by helping researchers and providers to better understand the evolving culture in which PC is delivered which will in turn, allow for the development of effective interventions to improve PC in the acute care setting.